Healthcare Provider Details

I. General information

NPI: 1366187478
Provider Name (Legal Business Name): ALEXANDRA GARRETT BOWMAN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2022
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

331 LAIDLEY ST STE 601
CHARLESTON WV
25301-1682
US

IV. Provider business mailing address

4605 MACCORKLE AVE SW
SOUTH CHARLESTON WV
25309-1311
US

V. Phone/Fax

Practice location:
  • Phone: 304-352-2663
  • Fax: 304-766-5610
Mailing address:
  • Phone: 304-766-3600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4128
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: